Regarding partial pulpatomy, VPT + direct composite
(What we remove from inside the tooth is much more important than what we place inside )
Saving the vitality of the tooth, if possible, is our goal and one of the most important steps in conservative dentistry , a young female patient, 25 years old, came with badly carious lower first molar with large defective amalgam filling. The x ray shows the extension of caries lesion into the pulp horn mesialy , and the sensibility test reveals the tooth still vital, no tenderness to percusion, the x ray shows normal periapical radiograph ,so the first step in the treatment plan was trying to save the vitality(after caries removal, the pulp exposed mesialy, the pulp removed with new sterile turbine bur , hemostasis achieved by using sodium hypochlorite and cotton,bioceramic putty applied), then direct composite done as long term temporary filling , the patient informed that after 6 months she should do indirect lithium disilicate overlay as a final restoration
Initial situation
After amalgam removal and cavity cleaning, large pulp exposure occure due to caries extension, so partial pulpatomy done
After achieving hemostasis with sodium hypochlorite
Bioceramic putty applied
Bioceramic covered by flowable light cure GIC
Direct composite
Final result
Post-operative x ray
7 months later
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